Provider Demographics
NPI:1437453461
Name:MAINE MEDICAL CENTER PLC
Entity Type:Organization
Organization Name:MAINE MEDICAL CENTER PLC
Other - Org Name:DOWN EAST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-385-2781
Mailing Address - Street 1:5555 GULL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-7640
Mailing Address - Country:US
Mailing Address - Phone:269-385-2781
Mailing Address - Fax:269-343-3450
Practice Address - Street 1:5555 GULL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-7640
Practice Address - Country:US
Practice Address - Phone:269-385-2781
Practice Address - Fax:269-343-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4232845 10Medicaid
MIB46159Medicare UPIN
MI4232845 10Medicaid